Monday, March 10, 2008

ERPC

We're back, a bit disgustingly, in the realm of medical jargon...

So, there's a minor gyn(a)ecological operation, dilation and curettage, or D&C, in which the cervix is dilated and stuff that doesn't need to be in the uterus is removed by one or another method. This term is used in both the US and UK, but in the UK, when the procedure takes place after a pregnancy (usually after a miscarriage), it is called an ERPC (sometimes ERPoC), or Evacuation of Retained Products of Conception. (I have found this term in a US medical journal, but when I said it to an American gyna(e)cologist, she was completely unfamiliar with it.)

Why the variation in the two countries? I have no idea. Any medical insights?

16 comments:

Politics? If you ban abortion (D&Cs) you can still allow ERPCs. If both procedures are called by the same name it makes it harder for abortions to continue under the name ERPC. Or am I just too cynical?

Because in the US, ERPC stands for endoscopic retrograde cholangiopancreatography. It's a diagnostic test for gall stones, among other things.

A D&C can be an early abortion procedure, later ones are called D&Es, Dilation and Evacuation. Although it requires anesthesia, it's a very fast, routine, and safe procedure. I suspect more than a few are actually abortions, in all but name.

AA, I don't buy the politics explanation for two reasons: (a) we're talking about the UK, where abortion rights are not constantly under threat, and (b) D&C is just a method that can be used for other things, like correcting for postpartum bleeding or a missed miscarriage. Any anti-abortion law would not ban D&Cs, it'd ban their use for abortions.

Dear lynneguist,According to what I know, these three terms are very well defined, three separate procedures.

D&C - Dilatation & CurettageDilatation of the Cervix to have access to Uterus & remove tissue (curettings) with an instrument (curette). It's a diagnostic as well as a therapeutic procedure, usually done in the menopausal/ perimenopausal women.

ERPC - Evacuation of Retained Products of ConceptionAs the names says, it's to evacuate products of conception that are left in the uterus after an Incomplete Abortion (usually occurring naturally). No need to Dilate the Cervix as already the cervix is open due to abortion occurring.

D&E - Dilatation & EvacuationDilatation of the Cervix & Evacuation of the products of conception, usually done in Missed Abortions where the products of conception does not have life (aborted), but has not come out of the uterus. This may be employed to artificially rip out a living fetus too.

These three procedures are completely different ones & serve different purposes.

So AA I don't think they have any political basis.

Also Zhoen, Endoscopic Retrograde CholangioPancreatography is ERCP if you checked it closely enough.All three procedures need Anaesthesia & are of course very fast & safe, with last two having their fare share of complications too.So between the two countries UK & US, the same procedures should have the same name, where they cannot be interchanged.

As others have pointed out, the ERPC is nowhere near the same thing as an ERCP.

I used to work in a hospital lab (in the US) where we received the tissue after D&Cs were performed, and it became evident that D&C could be the term used to describe the procedure whether products of conception were present or not; thus, in the US, the term D&C could be euphemistically applied to abortions, and it was. So as Lynne points out, the D&C in the imprecise US sense and the ERPC could be experienced as equivalent, probably rendered equivalent by usage. On a more humo(u)rous note, though all of us in the lab knew that most of the D&Cs going on in the hospital were abortions, we commonly referred to them as, "Dusting and Cleaning" !

Dear lynneguist,I am a Medical Doctor, presently an Anaesthetist & previously worked as a Obstetric & Gynaecology SHO & HO.So daily my present work requires me to give anaesthesia to patients undergoing these procedures. Also earlier when I was working as O&G SHO, I had to perform the procedure daily.So I have a clear understanding of the procedures & ERPC does not require dilatation of the Cervix (which is opening up the cervix), but may have to widen to insert the necessary instruments for the procedure.Although all three procedure are almost similar, they are very different in their indication as well as the procedure itself as I have mentioned earlier.

Maybe where you are, PRan, but not here. I've had three of the things, and the first stage is to give something to start the cervix dilating. If you haven't been in labo(u)r, then the cervix is not dilated--as is the case with missed miscarriages and post-caesarean operations.

From the Salisbury NHS Trust's leaflet 'A guide to having an ERPC': "During theoperation, the neck of the womb is gently stretched and any remaining tissue is removedusing gentle suction."

Lynne, I have had 2 ERPCs and my understanding from my gynaecologist ( in the UK) is that an ERPC is not the same as a D&C, it uses a vacuum rather than scraping the surface of the womb. That is, the difference is it is E rather than C. It is gentler which is why the UK docs prefer it. However I think with these ops there is always a risk that some of the womb lining is left behind, and the procedure then needs to be repeated. That may be why the US docs prefer to stick with the tried and tested D&C as it's tougher on the uterus and therefore less likely to leave something behind? I find in general the US docs are more conservative about treatment modalities, perhaps because of the risk of being sued.

A D&C can involve suction too (see the link to wikipedia in the post--D&C is often informally used instead of E&C, just because it's a more familiar term), and and ERPC can involve curettage as well as suction, as my first two did. Notice the definition from 'my clinical notes', quoted two comments above--it makes clear that an ERPC can involve suction or curettage.

The first time I had one, the gyn(a)ecologist explicitly said to me that it was the same procedure as a D&C, but that this name was used for the particular situation involved. Procedurally, they are the same. (US doctors don't stick to curettage--medically speaking, suction is more conservative because it involves less risk of perforation.)

The distinction also has a clear linguistic origin. D&C (once vulgarly - and in the days of an overwhelmingly male profession - known as "dust and clean") clearly comes from French. The other terms are home-grown in English.

How dare you call this a minor procedure. I have had this done following a molar miscarriage (I'm so sorry if I'm confusing you by using medical language here again but I think you'll find most of the general population are NOT actually morons and will ask or look up a term if they don't know what it means) It is a horrendous procedure both physically and mentally. I really think you should have some even minor clue about what you are talking about before you go blabbering all over the internet.

Dear Anonymous,I have had four of them. I have also had major surgery. I know the difference.

They are horrible because of what they mean to the person having them, but it's not major surgery. There are no incisions to the body.

This is a language blog, and at the time I was not talking about why I had this procedure. And since you don't know me or what I went through, I think the finger could be turned the other way re blabbering.

I nearly did not let your post through because I do not allow abusive posts--especially when they are posted anonymously. But I did want to respond to you. Should this escalate, however, I will delete the comment and this response.